Should Medicare Remove Total Knee Arthroplasty From Its Inpatient Only List? A Total Knee Arthroplasty Is Not a Partial Knee Arthroplasty

P. Maxwell Courtney, Mark I. Froimson, R. Meneghini, Gwo Chin Lee, Craig J. Della Valle

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: The Centers for Medicare and Medicaid Services have solicited comments to consider removing total knee arthroplasty (TKA) from the Inpatient Only list, as it has done for unicompartmental knee arthroplasty (UKA). The purpose of this study is to determine whether Medicare-aged patients undergoing TKA had comparable outcomes to those undergoing UKA. Methods: We queried the American College of Surgeons-National Surgical Quality Improvement Program database for all patients aged 65 years or older who underwent elective TKA or UKA from 2014 and 2015. Demographic variables, comorbidities, length of stay (LOS), 30-day complication, and readmission rates were compared between UKA and TKA patients. A multivariate regression analysis was then performed to identify independent risk factors for complications and hospital LOS greater than 1 day. Results: Of the 50,487 patients in the study, there were 49,136 (97%) TKA patients and 1351 UKA patients (3%). Medicare-aged TKA patients had a longer mean LOS (2.97 vs 1.57 days, P < .001), had a higher complication rate (9% vs 3%, P < .001), and were more likely to be discharged to a rehabilitation facility (31% vs 9%, P < .001) than Medicare-aged UKA patients. When controlling for other variables, TKA patients were more likely to experience a complication (odds ratio, 2.562; P < .001) and require LOS >1 day (odds ratio, 14.679; P < .001) than UKA patients. Conclusion: TKA procedure in the Medicare population is an independent risk factor for increased complications and LOS compared to UKA. Policymakers should use caution extrapolating UKA data to TKA patients and recognize the inherent disparities between the 2 procedures.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Knee Replacement Arthroplasties
Medicare
Inpatients
Length of Stay
Centers for Medicare and Medicaid Services (U.S.)
Quality Improvement

Keywords

  • Complications
  • Health policy
  • Outcomes
  • Total knee arthroplasty
  • Unicompartmental knee arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Should Medicare Remove Total Knee Arthroplasty From Its Inpatient Only List? A Total Knee Arthroplasty Is Not a Partial Knee Arthroplasty. / Courtney, P. Maxwell; Froimson, Mark I.; Meneghini, R.; Lee, Gwo Chin; Della Valle, Craig J.

In: Journal of Arthroplasty, 01.01.2017.

Research output: Contribution to journalArticle

@article{858c9c33080a448ba840aae72e319cef,
title = "Should Medicare Remove Total Knee Arthroplasty From Its Inpatient Only List? A Total Knee Arthroplasty Is Not a Partial Knee Arthroplasty",
abstract = "Background: The Centers for Medicare and Medicaid Services have solicited comments to consider removing total knee arthroplasty (TKA) from the Inpatient Only list, as it has done for unicompartmental knee arthroplasty (UKA). The purpose of this study is to determine whether Medicare-aged patients undergoing TKA had comparable outcomes to those undergoing UKA. Methods: We queried the American College of Surgeons-National Surgical Quality Improvement Program database for all patients aged 65 years or older who underwent elective TKA or UKA from 2014 and 2015. Demographic variables, comorbidities, length of stay (LOS), 30-day complication, and readmission rates were compared between UKA and TKA patients. A multivariate regression analysis was then performed to identify independent risk factors for complications and hospital LOS greater than 1 day. Results: Of the 50,487 patients in the study, there were 49,136 (97{\%}) TKA patients and 1351 UKA patients (3{\%}). Medicare-aged TKA patients had a longer mean LOS (2.97 vs 1.57 days, P < .001), had a higher complication rate (9{\%} vs 3{\%}, P < .001), and were more likely to be discharged to a rehabilitation facility (31{\%} vs 9{\%}, P < .001) than Medicare-aged UKA patients. When controlling for other variables, TKA patients were more likely to experience a complication (odds ratio, 2.562; P < .001) and require LOS >1 day (odds ratio, 14.679; P < .001) than UKA patients. Conclusion: TKA procedure in the Medicare population is an independent risk factor for increased complications and LOS compared to UKA. Policymakers should use caution extrapolating UKA data to TKA patients and recognize the inherent disparities between the 2 procedures.",
keywords = "Complications, Health policy, Outcomes, Total knee arthroplasty, Unicompartmental knee arthroplasty",
author = "Courtney, {P. Maxwell} and Froimson, {Mark I.} and R. Meneghini and Lee, {Gwo Chin} and {Della Valle}, {Craig J.}",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.arth.2017.11.028",
language = "English (US)",
journal = "Journal of Arthroplasty",
issn = "0883-5403",
publisher = "Churchill Livingstone",

}

TY - JOUR

T1 - Should Medicare Remove Total Knee Arthroplasty From Its Inpatient Only List? A Total Knee Arthroplasty Is Not a Partial Knee Arthroplasty

AU - Courtney, P. Maxwell

AU - Froimson, Mark I.

AU - Meneghini, R.

AU - Lee, Gwo Chin

AU - Della Valle, Craig J.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: The Centers for Medicare and Medicaid Services have solicited comments to consider removing total knee arthroplasty (TKA) from the Inpatient Only list, as it has done for unicompartmental knee arthroplasty (UKA). The purpose of this study is to determine whether Medicare-aged patients undergoing TKA had comparable outcomes to those undergoing UKA. Methods: We queried the American College of Surgeons-National Surgical Quality Improvement Program database for all patients aged 65 years or older who underwent elective TKA or UKA from 2014 and 2015. Demographic variables, comorbidities, length of stay (LOS), 30-day complication, and readmission rates were compared between UKA and TKA patients. A multivariate regression analysis was then performed to identify independent risk factors for complications and hospital LOS greater than 1 day. Results: Of the 50,487 patients in the study, there were 49,136 (97%) TKA patients and 1351 UKA patients (3%). Medicare-aged TKA patients had a longer mean LOS (2.97 vs 1.57 days, P < .001), had a higher complication rate (9% vs 3%, P < .001), and were more likely to be discharged to a rehabilitation facility (31% vs 9%, P < .001) than Medicare-aged UKA patients. When controlling for other variables, TKA patients were more likely to experience a complication (odds ratio, 2.562; P < .001) and require LOS >1 day (odds ratio, 14.679; P < .001) than UKA patients. Conclusion: TKA procedure in the Medicare population is an independent risk factor for increased complications and LOS compared to UKA. Policymakers should use caution extrapolating UKA data to TKA patients and recognize the inherent disparities between the 2 procedures.

AB - Background: The Centers for Medicare and Medicaid Services have solicited comments to consider removing total knee arthroplasty (TKA) from the Inpatient Only list, as it has done for unicompartmental knee arthroplasty (UKA). The purpose of this study is to determine whether Medicare-aged patients undergoing TKA had comparable outcomes to those undergoing UKA. Methods: We queried the American College of Surgeons-National Surgical Quality Improvement Program database for all patients aged 65 years or older who underwent elective TKA or UKA from 2014 and 2015. Demographic variables, comorbidities, length of stay (LOS), 30-day complication, and readmission rates were compared between UKA and TKA patients. A multivariate regression analysis was then performed to identify independent risk factors for complications and hospital LOS greater than 1 day. Results: Of the 50,487 patients in the study, there were 49,136 (97%) TKA patients and 1351 UKA patients (3%). Medicare-aged TKA patients had a longer mean LOS (2.97 vs 1.57 days, P < .001), had a higher complication rate (9% vs 3%, P < .001), and were more likely to be discharged to a rehabilitation facility (31% vs 9%, P < .001) than Medicare-aged UKA patients. When controlling for other variables, TKA patients were more likely to experience a complication (odds ratio, 2.562; P < .001) and require LOS >1 day (odds ratio, 14.679; P < .001) than UKA patients. Conclusion: TKA procedure in the Medicare population is an independent risk factor for increased complications and LOS compared to UKA. Policymakers should use caution extrapolating UKA data to TKA patients and recognize the inherent disparities between the 2 procedures.

KW - Complications

KW - Health policy

KW - Outcomes

KW - Total knee arthroplasty

KW - Unicompartmental knee arthroplasty

UR - http://www.scopus.com/inward/record.url?scp=85035745773&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85035745773&partnerID=8YFLogxK

U2 - 10.1016/j.arth.2017.11.028

DO - 10.1016/j.arth.2017.11.028

M3 - Article

JO - Journal of Arthroplasty

JF - Journal of Arthroplasty

SN - 0883-5403

ER -